| NPI | 1700231479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE ING President 708-448-7772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 038003416) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2016-05-05 |